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Published on: July 4, 2019

Intra-abdominal infections

Fredric M Pieracci1, Philip S Barie

  • 1Department of Surgery and Public Health, Weill Medical College of Cornell University, New York, New York, USA.

Current Opinion in Critical Care
|June 30, 2007
PubMed
Abstract

Insights

Effective management of intra-abdominal infections in critically ill patients requires timely source control and judicious antimicrobial therapy. Novel approaches are emerging for gastrointestinal tract restoration and combating multidrug-resistant pathogens.

Area of Science:

  • Critical care medicine
  • Infectious diseases
  • Surgical critical care

Background:

  • Intra-abdominal infections (IAIs) present significant challenges in critically ill patients.
  • Treatment traditionally involves source control, antimicrobial therapy, and managing immune/coagulation responses.

Purpose of the Study:

  • To review recent advancements in the three primary treatment modalities for IAIs in critical illness.
  • To highlight emerging strategies for source control and antimicrobial use.

Main Methods:

  • Review of current literature on intra-abdominal infections in critically ill patients.
  • Analysis of recent findings regarding surgical management, antimicrobial strategies, and immunomodulation.

Main Results:

  • On-demand re-laparotomy is comparable to planned re-laparotomy or open-abdomen management for survival.
  • Novel gastrointestinal tract restoration techniques offer alternatives to invasive surgery.
  • Shorter-course antimicrobial therapy shows promise against multidrug-resistant pathogens.
  • Recombinant human activated protein C may benefit high-risk severe abdominal sepsis patients.

Conclusions:

  • Evidence-based recommendations for IAIs in critically ill patients are limited due to infrequent RCT participation.
  • Prioritizing timely and adequate source control is paramount.
  • Antimicrobial therapy should be tailored based on individual risk factors for multidrug-resistant pathogens.

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